Book Review

General Practice

N Engl J Med 1995; 332:1041April 13, 1995

Article

General Practice
By John Murtagh. 1107 pp., illustrated. New York, McGraw-Hill, 1994. $79. ISBN: 0-07-452807-6

Medical schools are scrambling to meet society's demand for primary care physicians by developing educational programs that address the knowledge, skills, and attitudes critical for providing high-quality primary care. The first step is to define the core curriculum, followed by steps to develop the processes to teach, evaluate, and refine that curriculum. But where are the textbooks that address even the first step? Murtagh, a highly experienced professor of general practice in Australia, provides a new textbook for general ambulatory practice, which accounts for the bulk of the core curriculum.

Throughout the book, Murtagh offers thoughtful distillations of his front-line experience and wisdom. In the first part, “The Basis of General Practice,” he highlights the ingredients necessary to care for the whole patient within the context of family and community. He offers frequent practical examples of good, old-fashioned communication and counseling skills that are essential for today's physician. After outlining basic diagnostic strategies applicable to all patients, Murtagh devotes a large portion of the book to “Problem Solving in General Practice,” with the material presented in a user-friendly format. Each chapter begins with key facts and terminology for common presenting problems and then provides clear diagnostic and clinical approaches, with attention to classic pitfalls and helpful tips. The rest of the book covers specific topics, such as disorders in children, women, and men; ongoing management issues; and emergency medicine.

Although General Practice offers many practical clinical approaches, I cannot recommend it as the main textbook for medical students or new graduates. The book's concise style assumes a fair amount of background knowledge that is often lacking in students early in their clinical experience. Other barriers for students in the United States are the frequent references to different drug brand names and preparations, the use of SI (Système International) units of measurement for laboratory tests, and the use of abbreviations for medical terminology.

The main reference textbook that has been available for family-medicine clerkships in the United States is The Text-book of Family Practice, edited by Robert E. Rakel (4th ed. Philadelphia: W.B. Saunders, 1990). However, many family-medicine clerkships provide syllabuses, or abbreviated texts, that address the need for both specific core content and curricular breadth. Students then choose reference textbooks in internal medicine, pediatrics, surgery, and obstetrics and gynecology. This group of books obviously provides more depth than any one book could hope to achieve. Unfortunately, despite its merits, General Practice gives us no reason to change this approach.

Mary Y. Lee, M.D.
Tufts University School of Medicine, Boston, MA 02111